[1]骆晓飞,魏瑄,王金良,等.氨甲环酸对全膝关节置换术中应用止血带造成的缺血再灌注损伤的影响[J].中医正骨,2019,31(06):12-17.
　LUO Xiaofei,WEI Xuan,WANG Jinliang,et al.Effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(06):12-17.
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氨甲环酸对全膝关节置换术中应用止血带造成的缺血再灌注损伤的影响()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期数:
2019年06期
页码:
12-17
栏目:
临床研究
出版日期:
2019-06-20

文章信息/Info

Title:
Effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty
作者:
骆晓飞; 魏瑄; 王金良; 王少华
(郑州市骨科医院,河南 郑州 450052)
Author(s):
LUO Xiaofei; WEI Xuan; WANG Jinliang; WANG Shaohua
Zhengzhou Orthopedic Hospital,Zhengzhou 450052,Henan,China
关键词:
关节成形术; 置换; 膝;  再灌注损伤;  止血带;  氨甲环酸;  白细胞介素6;  肿瘤坏死因子α
Keywords:
arthroplasty; replacement; knee;  reperfusion injury;  tourniquets;  tranexamic acid;  interleukin-6;  tumor necrosis factor-alpha
摘要:
目的:探讨氨甲环酸对全膝关节置换(total knee arthroplasty,TKA)术中应用止血带造成的缺血再灌注损伤的影响。方法:膝骨关节炎患者60例,男19例、女41例; 年龄61～79岁,中位数68岁; 病程3～20年,中位数8年。随机分为氨甲环酸组和生理盐水组,每组30例。均行初次单侧全膝关节置换术,手术全程上充气止血带,放置负压引流管。分别于术中安装假体后和术后3 h,氨甲环酸组给予氨甲环酸1 g加入100 mL生理盐水中静脉滴注,生理盐水组给予生理盐水100 mL静脉滴注。术中缝合关节囊后,氨甲环酸组给予氨甲环酸1 g加入100 mL生理盐水中关节腔局部灌注,生理盐水组给予生理盐水100 mL关节腔局部灌注。术后负压引流管夹闭3 h后间断开放,术后24 h拔除引流管。记录2组患者手术时间、术中出血量及术后24 h负压引流量。分别于术前、术后24 h、术后72 h时肘静脉采血5 mL,术后24 h拔除引流管时取引流液10 mL。采用酶联免疫法检测外周血血清中和关节腔引流液中白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)含量。结果:①一般结果。2组患者均顺利完成手术,手术时间、术中出血量的组间差异均无统计学意义[(73.4±6.5)min,(70.2±8.2)min,t=1.636,P=0.326;(65±11)mL,(62±15)mL,t=0.824,P=0.428],氨甲环酸组术后24 h引流量少于生理盐水组[(217±35)mL,(467±52)mL,t=21.710,P=0.000]。②2组患者手术前后外周血血清中IL-6含量检测结果。时间因素和分组因素存在交互效应(F=12.312,P=0.000); 2组患者外周血血清中IL-6含量的组间总体比较,差异有统计学意义,即存在分组效应(F=3.214,P=0.001); 不同时间点间外周血血清中IL-6含量总体比较,差异有统计学意义,即存在时间效应(F=16.531,P=0.000); 2组患者手术前后外周血血清中IL-6含量均呈先增高后降低的趋势,但2组的趋势不完全一致[氨甲环酸组:(6.23±1.65)pg·mL-1,(28.13±4.21)pg·mL-1,(22.09±2.75)pg·mL-1; 生理盐水组:(6.41±2.02)pg·mL-1,(37.54±5.31)pg·mL-1,(32.52±3.01)pg·mL-1]; 术前2组患者外周血血清中IL-6含量的组间差异无统计学意义(t=1.567,P=0.268); 术后24 h和术后72 h时,氨甲环酸组患者外周血血清中IL-6含量均低于生理盐水组(t=3.553,P=0.001; t=4.537,P=0.000)。③2组患者手术前后外周血血清中TNF-α含量检测结果。时间因素和分组因素存在交互效应(F=17.312,P=0.000); 2组患者外周血血清中TNF-α含量的组间总体比较,差异有统计学意义,即存在分组效应(F=4.318,P=0.000); 不同时间点间外周血血清中TNF-α含量总体比较,差异有统计学意义,即存在时间效应(F=15.231,P=0.000); 2组患者手术前后外周血血清中TNF-α含量均呈先增高后降低的趋势,但2组的趋势不完全一致[氨甲环酸组:(20.51±3.61)pg·mL-1,(35.33±4.35)pg·mL-1,(31.32±2.98)pg·mL-1; 生理盐水组:(19.82±2.96)pg·mL-1,(42.85±3.87)pg·mL-1,(37.76±3.62)pg·mL-1]; 术前2组患者外周血血清中TNF-α含量的组间差异无统计学意义(t=1.312,P=0.316); 术后24 h和术后72 h时,氨甲环酸组患者外周血血清中TNF-α含量均低于生理盐水组(t=5.124,P=0.000; t=3.317,P=0.001)。④2组患者术后关节腔引流液中IL-6、TNF-α含量检测结果。氨甲环酸组术后关节腔引流液中IL-6、TNF-α含量均低于生理盐水组[(30.23±3.42)pg·mL-1,(38.78±4.15)pg·mL-1,t=2.637,P=0.018;(31.65±4.27)pg·mL-1,(41.24±4.83)pg·mL-1,t=3.281,P=0.001]。结论:在TKA术中静脉滴注结合关节腔灌注氨甲环酸,有利于减轻应用止血带造成的缺血再灌注损伤。
Abstract:
Objective:To explore the effects of tranexamic acid on ischemia-reperfusion injury caused by application of tourniquet in the surgery of total knee arthroplasty(TKA).Methods:Sixty patients with knee osteoarthritis(KOA)were randomly divided into tranexamic acid group and normal saline(NS)group,30 cases in each group.The patients consisted of 19 males and 41 females,and ranged in age from 61 to 79 years(Median=68 yrs)and in disease course from 3 to 20 years(Median=8 yrs).The primary unilateral TKA were performed on all patients in the 2 groups.A pneumatic tourniquet was used during the whole surgery and a negative-pressure drainage tube was placed before the incision was closed.The patients in tranexamic acid group were treated with intravenous drip of tranexamic acid(1 g)dissolved in 100 mL of NS,while the patients in NS group were treated with intravenous drip of 100 mL of NS after the prosthesis was installed in the surgery and at 3 hours after the surgery respectively.After the joint capsule was sutured in the surgery,the patients in tranexamic acid group were treated with intraarticular local perfusion with tranexamic acid(1 g)dissolved in 100 mL of NS,while the patients in NS group were treated with intraarticular local perfusion with 100 mL of NS.The negative-pressure drainage tube was closed for 3 hours and then was released intermittently.The drainage tube was removed at 24 hours after the surgery.The operative time,intraoperative blood loss and postoperative 24-hour negative-pressure drainage volume were recorded and compared between the 2 groups.The blood(5 mL)was fetched out from ulnar vein before the surgery and at 24 and 72 hours after the surgery respectively,and the drainage fluid(10 mL)was fetched when the drainage tube was removed at 24 hours after the surgery.The contents of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in peripheral blood serum and intra-articular drainage fluid were detected by using enzyme linked immunosorbent assays.Results:The surgeries were finished successfully in all patients.There was no statistical difference in operative time and intraoperative blood loss between the 2 groups(73.4+/-6.5 vs 70.2+/-8.2 min,t=1.636,P=0.326; 65+/-11 vs 62+/-15 mL,t=0.824,P=0.428).The postoperative 24-hour negative-pressure drainage volume was less in tranexamic acid group compared to NS group(217+/-35 vs 467+/-52 mL,t=21.710,P=0.000).There was interaction between time factor and group factor in contents of IL-6 in peripheral blood serum(F=12.312,P=0.000).There was statistical difference in the contents of IL-6 in peripheral blood serum between the 2 groups in general,in other words,there was group effect(F=3.214,P=0.001).There was statistical difference in the contents of IL-6 in peripheral blood serum between different timepoints,in other words,there was time effect(F=16.531,P=0.000).The contents of IL-6 in peripheral blood serum presented a time-dependent trend of increasing firstly and decreasing subsequently in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(tranexamic acid group:6.23+/-1.65,28.13+/-4.21,22.09+/-2.75 pg/mL; NS group:6.41+/-2.02,37.54+/-5.31,32.52+/-3.01 pg/mL).There was no statistical difference in the contents of IL-6 in peripheral blood serum between the 2 groups before the surgery(t=1.567,P=0.268).The contents of IL-6 in peripheral blood serum were lower in tranexamic acid group compared to NS group at 24 and 72 hours after the surgery(t=3.553,P=0.001; t=4.537,P=0.000).There was interaction between time factor and group factor in contents of TNF-α in peripheral blood serum(F=17.312,P=0.000).There was statistical difference in the contents of TNF-α in peripheral blood serum between the 2 groups in general,in other words,there was group effect(F=4.318,P=0.000).There was statistical difference in the contents of TNF-α in peripheral blood serum between different timepoints,in other words,there was time effect(F=15.231,P=0.000).The contents of TNF-α in peripheral blood serum presented a time-dependent trend of increasing firstly and decreasing subsequently in both of the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(tranexamic acid group:20.51+/-3.61,35.33+/-4.35,31.32+/-2.98 pg/mL; NS group:19.82+/-2.96,42.85+/-3.87,37.76+/-3.62 pg/mL).There was no statistical difference in the contents of TNF-α in peripheral blood serum between the 2 groups before the surgery(t=1.312,P=0.316).The contents of TNF-α in peripheral blood serum were lower in tranexamic acid group compared to NS group at 24 and 72 hours after the surgery(t=5.124,P=0.000; t=3.317,P=0.001).The contents of IL-6 and TNF-α in postoperative intra-articular drainage fluid were lower in tranexamic acid group compared to NS group(30.23+/-3.42 vs 38.78+/-4.15 pg/mL,t=2.637,P=0.018; 31.65+/-4.27 vs 41.24+/-4.83 pg/mL,t=3.281,P=0.001).Conclusion:Intravenous drip of tranexamic acid and intraarticular perfusion with tranexamic acid are helpful for reducing the ischemia-reperfusion injury caused by application of tourniquet in the surgery of TKA.

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备注/Memo

备注/Memo:
基金项目:郑州市科技发展计划项目(20150138) 通讯作者:魏瑄 E-mail:vxuan@sina.com(收稿日期:2019-03-16 本文编辑:杨雅)
更新日期/Last Update: 1900-01-01